Imaginaries of patienthood: Constructions of HIV patients by HIV specialist health professionals

Abstract

This paper explores the ways in which HIV specialists based in the United Kingdom (UK) construct, conceptualise and imagine their patient group via the concept of the 'imaginary', a notion encompassing the symbols, concepts and values through which people make sense of their social environment. In discussing their work with men who have sex with men (MSM), practitioners described patients as knowledgeable and highly adherent to treatment, yet apt to pursue hedonistic lives involving sex and recreational drugs. Recent innovations in treatment were formulated in terms of optimism and progress and the ascent of biomedical approaches was cast as an advance over former emphases on psychosocial interventions and attempts to facilitate behaviour change. In contrast to the imaginary of patients who were well-informed and highly compliant with treatment, participants also sought to explain those who were not easily enfolded within modern treatment regimens or who were seen to be overly emotional. These patients, it was said, had some pre-existing psychological problem or perhaps were especially vulnerable to societal pressures. Overall, the imaginary of the public was

Public health services and intersectional stigma: a social sciences perspective with implications for HIV service design and delivery

“…Beyond tangible objects or processes that include or are embedded in health systems and clinics, structures and systems can also exist intangibly, such as in knowledge systems and normative structures. A study examining how HIV specialists construct and imagine patients found that these physicians described an ‘imaginary’ of gay, bisexual and other men who have sex with men as not just being risk-takers but also self-aware and knowledgeable compared to other patient populations [35 ▪ ]. The study also expressed a sense of biotechnological optimism, potentially at the expense of psychosocial interventions.…”

“…These have major implications for stigma, given that labelling and stereotyping processes are in motion. Medical sociologists have also previously cautioned against the medicalization of social life, as an overemphasis on the biomedical may lead to imbalances in power and have implications for how patients navigate or experience health services [35 ▪ ]. Furthermore, with increasing discourse and normalization around concepts like ‘undetectable = untransmittable’ [36], research has also shown that not all local contexts construct or integrate such global discourses in similar ways, and a deeper understanding of how cultural values and expectations shape ideas of HIV normality [37 ▪▪ ].…”